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Incident open-angle glaucoma and intraocular pressure.
Ophthalmology 2007; 114(10):1810-5O

Abstract

PURPOSE

To evaluate the role of baseline intraocular pressure (b-IOP) as a risk factor for incident open-angle glaucoma (OAG) in participants of African origin from the Barbados Eye Studies.

DESIGN

Population-based 9-year cohort study.

PARTICIPANTS

Three thousand two hundred twenty-two persons examined during the study period who were free of glaucoma at baseline and at risk of developing OAG during the 9-year follow-up.

METHODS

Study protocols were standardized and included ophthalmic and other measurements, automated perimetry, applanation tonometry, fundus photography, and comprehensive ophthalmologic examination for those referred. The product-limit approach was used to estimate incidence. Relationships between b-IOP and incidence were evaluated by adjusted relative risk ratios (RRs) with 95% confidence intervals (CIs), based on Cox regression models.

MAIN OUTCOME MEASURE

The 9-year incidence of OAG was based on both visual field and optic disc abnormalities, with ophthalmologic evaluations to exclude other possible causes.

RESULTS

The overall 9-year incidence of OAG was 4.4% (95% CI, 3.7%-5.2%), and the mean (standard deviation) b-IOP among persons at risk was 18.0 mmHg (4.1). Among the 125 incident OAG cases, the mean b-IOP was 21.9 mmHg and 46% had b-IOP of >21 mmHg. In contrast, the nonincident group had a mean b-IOP of 17.8 mmHg and only 12% had b-IOP of >21 mmHg. Overall, OAG risk increased by 12% with each 1-mmHg increase in IOP (RR, 1.12; 95% CI, 1.08-1.16). Incidence steadily increased from 1.8% (95% CI, 1.2%-2.7%) for persons with b-IOP of < or =17 mmHg (referent group) to 22.3% (95% CI, 15.8%-31.1%) for those with b-IOP > 25 mmHg, resulting in an adjusted RR of 13.1 (95% CI, 7.1-24.1) among the latter group. The attributable risk for IOP of >25 mmHg was 19%. Using 21 mmHg as a cutoff, the RR was 7.9 (95% CI, 3.8-16.2) and the attributable risk was 37%.

CONCLUSIONS

After 9 years' follow-up, the risk of OAG was positively related to IOP levels at baseline. Although persons with b-IOP of >25 mmHg had a 13-fold RR of developing OAG, most cases arose with lower b-IOP. This study thus confirms the role of IOP as an influential risk factor, yet at the same time underscores its limitations in predicting OAG.

Authors+Show Affiliations

Department of Preventive Medicine, Stony Brook University, Stony Brook, New York 11794-8036, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17583352

Citation

Nemesure, B, et al. "Incident Open-angle Glaucoma and Intraocular Pressure." Ophthalmology, vol. 114, no. 10, 2007, pp. 1810-5.
Nemesure B, Honkanen R, Hennis A, et al. Incident open-angle glaucoma and intraocular pressure. Ophthalmology. 2007;114(10):1810-5.
Nemesure, B., Honkanen, R., Hennis, A., Wu, S. Y., & Leske, M. C. (2007). Incident open-angle glaucoma and intraocular pressure. Ophthalmology, 114(10), pp. 1810-5.
Nemesure B, et al. Incident Open-angle Glaucoma and Intraocular Pressure. Ophthalmology. 2007;114(10):1810-5. PubMed PMID: 17583352.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incident open-angle glaucoma and intraocular pressure. AU - Nemesure,B, AU - Honkanen,R, AU - Hennis,A, AU - Wu,S Y, AU - Leske,M Cristina, AU - ,, Y1 - 2007/06/20/ PY - 2006/08/22/received PY - 2007/04/03/revised PY - 2007/04/04/accepted PY - 2007/6/23/pubmed PY - 2007/10/19/medline PY - 2007/6/23/entrez SP - 1810 EP - 5 JF - Ophthalmology JO - Ophthalmology VL - 114 IS - 10 N2 - PURPOSE: To evaluate the role of baseline intraocular pressure (b-IOP) as a risk factor for incident open-angle glaucoma (OAG) in participants of African origin from the Barbados Eye Studies. DESIGN: Population-based 9-year cohort study. PARTICIPANTS: Three thousand two hundred twenty-two persons examined during the study period who were free of glaucoma at baseline and at risk of developing OAG during the 9-year follow-up. METHODS: Study protocols were standardized and included ophthalmic and other measurements, automated perimetry, applanation tonometry, fundus photography, and comprehensive ophthalmologic examination for those referred. The product-limit approach was used to estimate incidence. Relationships between b-IOP and incidence were evaluated by adjusted relative risk ratios (RRs) with 95% confidence intervals (CIs), based on Cox regression models. MAIN OUTCOME MEASURE: The 9-year incidence of OAG was based on both visual field and optic disc abnormalities, with ophthalmologic evaluations to exclude other possible causes. RESULTS: The overall 9-year incidence of OAG was 4.4% (95% CI, 3.7%-5.2%), and the mean (standard deviation) b-IOP among persons at risk was 18.0 mmHg (4.1). Among the 125 incident OAG cases, the mean b-IOP was 21.9 mmHg and 46% had b-IOP of >21 mmHg. In contrast, the nonincident group had a mean b-IOP of 17.8 mmHg and only 12% had b-IOP of >21 mmHg. Overall, OAG risk increased by 12% with each 1-mmHg increase in IOP (RR, 1.12; 95% CI, 1.08-1.16). Incidence steadily increased from 1.8% (95% CI, 1.2%-2.7%) for persons with b-IOP of < or =17 mmHg (referent group) to 22.3% (95% CI, 15.8%-31.1%) for those with b-IOP > 25 mmHg, resulting in an adjusted RR of 13.1 (95% CI, 7.1-24.1) among the latter group. The attributable risk for IOP of >25 mmHg was 19%. Using 21 mmHg as a cutoff, the RR was 7.9 (95% CI, 3.8-16.2) and the attributable risk was 37%. CONCLUSIONS: After 9 years' follow-up, the risk of OAG was positively related to IOP levels at baseline. Although persons with b-IOP of >25 mmHg had a 13-fold RR of developing OAG, most cases arose with lower b-IOP. This study thus confirms the role of IOP as an influential risk factor, yet at the same time underscores its limitations in predicting OAG. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/17583352/Incident_open_angle_glaucoma_and_intraocular_pressure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(07)00372-7 DB - PRIME DP - Unbound Medicine ER -